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<div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_12' ><form method='post' enctype='multipart/form-data' id='gform_12' action='/reputation-management/' >
<div class='gform_body gform-body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id="field_12_1" class="gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_12_1' >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_12_1' type='text' value='' class='medium' placeholder='Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_12_2" class="gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_12_2' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
<input name='input_2' id='input_12_2' type='text' value='' class='medium' placeholder='Email' aria-required="true" aria-invalid="false" />
</div></li><li id="field_12_3" class="gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible" ><label class='gfield_label' for='input_12_3' >URL<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_12_3' type='text' value='' class='medium' placeholder='URL' aria-required="true" aria-invalid="false" /> </div></li><li id="field_12_4" class="gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_4' >Name</label><div class='ginput_container'><input name='input_4' id='input_12_4' type='text' value='' /></div><div class='gfield_description' id='gfield_description_12_4'>This field is for validation purposes and should be left unchanged.</div></li></ul></div>
<div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_12' class='gform_button button' value='GET MY FREE REPORT' onclick='if(window["gf_submitting_12"]){return false;} window["gf_submitting_12"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_12"]){return false;} window["gf_submitting_12"]=true; jQuery("#gform_12").trigger("submit",[true]); }' />
<input type='hidden' class='gform_hidden' name='is_submit_12' value='1' />
<input type='hidden' class='gform_hidden' name='gform_submit' value='12' />
<input type='hidden' class='gform_hidden' name='gform_unique_id' value='' />
<input type='hidden' class='gform_hidden' name='state_12' value='WyJbXSIsImEwOTY5NTJhMWMxYWMzNTk2YWM4Njg3ZDljMmY3NzZkIl0=' />
<input type='hidden' class='gform_hidden' name='gform_target_page_number_12' id='gform_target_page_number_12' value='0' />
<input type='hidden' class='gform_hidden' name='gform_source_page_number_12' id='gform_source_page_number_12' value='1' />
<input type='hidden' name='gform_field_values' value='' />
</div>
</form>
</div>
